Psychotherapy for bulimia

Bulimia nervosa - Diagnosis and treatment


If your primary care provider suspects you have bulimia, he or she will typically:

  • Talk to you about your eating habits, weight-loss methods and physical symptoms
  • Do a physical exam
  • Request blood and urine tests
  • Request a test that can identify problems with your heart (electrocardiogram)
  • Perform a psychological evaluation, including a discussion of your attitude toward your body and weight
  • Use the criteria for bulimia listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

Your primary care provider may also request additional tests to help pinpoint a diagnosis, rule out medical causes for weight changes and check for any related complications.

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  • Electrocardiogram (ECG or EKG)
  • Urinalysis
  • X-ray


When you have bulimia, you may need several types of treatment, although combining psychotherapy with antidepressants may be the most effective for overcoming the disorder.

Treatment generally involves a team approach that includes you, your family, your primary care provider, a mental health professional and a dietitian experienced in treating eating disorders. You may have a case manager to coordinate your care.

Here's a look at bulimia treatment options and considerations.


Psychotherapy, also known as talk therapy or psychological counseling, involves discussing your bulimia and related issues with a mental health professional. Evidence indicates that these types of psychotherapy help improve symptoms of bulimia:

  • Cognitive behavioral therapy to help you normalize your eating patterns and identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones
  • Family-based treatment to help parents intervene to stop their teenager's unhealthy eating behaviors, to help the teen regain control over his or her eating, and to help the family deal with problems that bulimia can have on the teen's development and the family
  • Interpersonal psychotherapy, which addresses difficulties in your close relationships, helping to improve your communication and problem-solving skills

Ask your mental health professional which psychotherapy he or she will use and what evidence exists that shows it's beneficial in treating bulimia.


Antidepressants may help reduce the symptoms of bulimia when used along with psychotherapy. The only antidepressant specifically approved by the Food and Drug Administration to treat bulimia is fluoxetine (Prozac), a type of selective serotonin reuptake inhibitor (SSRI), which may help even if you're not depressed.

Nutrition education

Dietitians can design an eating plan to help you achieve healthy eating habits to avoid hunger and cravings and to provide good nutrition. Eating regularly and not restricting your food intake is important in overcoming bulimia.


Bulimia can usually be treated outside of the hospital. But if symptoms are severe, with serious health complications, you may need treatment in a hospital. Some eating disorder programs may offer day treatment rather than inpatient hospitalization.

Treatment challenges in bulimia

Although most people with bulimia do recover, some find that symptoms don't go away entirely. Periods of bingeing and purging may come and go through the years, depending on your life circumstances, such as recurrence during times of high stress.

If you find yourself back in the binge-purge cycle, follow-up sessions with your primary care provider, dietitian and/or mental health professional may help you weather the crisis before your eating disorder spirals out of control again. Learning positive ways to cope, creating healthy relationships and managing stress can help prevent a relapse.

If you've had an eating disorder in the past and you notice your symptoms returning, seek help from your medical team immediately.

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  • Cognitive behavioral therapy
  • Family therapy
  • Psychotherapy

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Lifestyle and home remedies

In addition to professional treatment, follow these self-care tips:

  • Stick to your treatment plan. Don't skip therapy sessions and try not to stray from meal plans, even if they make you uncomfortable.
  • Learn about bulimia. Education about your condition can empower you and motivate you to stick to your treatment plan.
  • Get the right nutrition. If you aren't eating well or you're frequently purging, it's likely your body isn't getting all of the nutrients it needs. Talk to your primary care provider or dietitian about appropriate vitamin and mineral supplements. However, getting most of your vitamins and minerals from food is typically recommended.
  • Stay in touch. Don't isolate yourself from caring family members and friends who want to see you get healthy. Understand that they have your best interests at heart and that nurturing, caring relationships are healthy for you.
  • Be kind to yourself. Resist urges to weigh yourself or check yourself in the mirror frequently. These may do nothing but fuel your drive to maintain unhealthy habits.
  • Be cautious with exercise. Talk to your primary care provider about what kind of physical activity, if any, is appropriate for you, especially if you exercise excessively to burn off post-binge calories.

Alternative medicine

Dietary supplements and herbal products designed to suppress the appetite or aid in weight loss may be abused by people with eating disorders. Weight-loss supplements or herbs can have serious side effects and dangerously interact with other medications.

Weight-loss and other dietary supplements don't need approval by the Food and Drug Administration (FDA) to go on the market. And natural doesn't always mean safe. If you choose to use dietary supplements or herbs, discuss the potential risks with your primary care provider.

Coping and support

You may find it difficult to cope with bulimia when you're hit with mixed messages by the media, culture, coaches, family, and maybe your own friends or peers. So how do you cope with a disease that can be deadly when you're also getting messages that being thin is a sign of success?

  • Remind yourself what a healthy weight is for your body.
  • Resist the urge to diet or skip meals, which can trigger binge eating.
  • Don't visit websites that advocate or glorify eating disorders.
  • Identify troublesome situations that trigger thoughts or behaviors that may contribute to your bulimia, and develop a plan to deal with them.
  • Have a plan in place to cope with the emotional distress of setbacks.
  • Look for positive role models who can help boost your self-esteem.
  • Find pleasurable activities and hobbies that can help distract you from thoughts about bingeing and purging.
  • Build up your self-esteem by forgiving yourself, focusing on the positive, and giving yourself credit and encouragement.

Get support

If you have bulimia, you and your family may find support groups helpful for encouragement, hope and advice on coping. Group members can truly understand what you're going through because they've been there. Ask your doctor if he or she knows of a group in your area.

Coping advice for parents

If you're the parent of someone with bulimia, you may blame yourself for your child's eating disorder. But eating disorders have many causes, and parenting style is not considered a cause. It's best to focus on how you can help your child now.

Here are some suggestions:

  • Ask your child what you can do to help. For example, ask if your teenager would like you to plan family activities after meals to reduce the temptation to purge.
  • Listen. Allow your child to express feelings.
  • Schedule regular family mealtimes. Eating at routine times is important to help reduce binge eating.
  • Let your teenager know any concerns you have. But do this without placing blame.

Remember that eating disorders affect the whole family, and you need to take care of yourself, too. If you feel that you aren't coping well with your teen's bulimia, you might benefit from professional counseling. Or ask your child's primary care provider about support groups for parents of children with eating disorders.

Preparing for your appointment

Here's some information to help you get ready for your appointment, and what to expect from your health care team. Ask a family member or friend to go with you, if possible, to help you remember key points and give a fuller picture of the situation.

What you can do

Before your appointment, make a list of:

  • Your symptoms, even those that may seem unrelated to the reason for your appointment
  • Key personal information, including any major stresses or recent life changes
  • All medications, vitamins, herbal products, over-the-counter medications or other supplements you're taking, and their dosages
  • Questions to ask your doctor, so you can make the most of your time together

Some questions to ask your primary care provider or mental health professional include:

  • What kinds of tests do I need? Do these tests require any special preparation?
  • What treatments are available, and which do you recommend?
  • Is there a generic alternative to the medicine you're prescribing for me?
  • How will treatment affect my weight?
  • Are there any brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your primary care provider or mental health professional will likely ask you a number of questions. He or she may ask:

  • How long have you been worried about your weight?
  • Do you think about food often?
  • Do you ever eat in secret?
  • Have you ever vomited because you were uncomfortably full?
  • Have you ever taken medications for weight loss?
  • Do you exercise? If so, how often?
  • Have you found any other ways to lose weight?
  • Are you having any physical symptoms?
  • Have any of your family members ever had symptoms of an eating disorder, or have any been diagnosed with an eating disorder?

Your primary care provider or mental health professional will ask additional questions based on your responses, symptoms and needs. Preparing and anticipating questions will help you make the most of your appointment time.

By Mayo Clinic Staff


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Bulimia Nervosa Treatment - Medications, Therapies, Self-Care, and Specialists

Written by WebMD Editorial Contributors

What Is the Treatment for Bulimia?

The primary treatment for bulimia often combines psychotherapy, antidepressants, and nutritional counseling.

It is helpful to find a psychologist or psychiatrist experienced in dealing with eating disorders. The same is true for nutritional counseling, whether the patient sees the family doctor or another health professional.

Clinics that specialize in eating disorders can often provide psychiatrists, psychotherapists, and nutritionists. All therapists involved should work in close cooperation with one another.

Psychotherapy and Bulimia

Psychological treatments for bulimia may involve individual, family, or group psychotherapy. Behavior or cognitive therapies are often prescribed, as well. Behavior therapy focuses on altering habits (such as bingeing and purging). Sessions are usually devoted to analyzing the behavior and devising ways to change it, and the patient follows specific instructions between sessions.

Cognitive therapy focuses on exploring and countering the negative thoughts that underlie destructive habits. Individual or group psychotherapy focuses on the underlying emotional experiences and relationships that have contributed to the bulimia.

Medications for Bulimia

Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) -- including Celexa, Lexapro, Prozac, and Zoloft -- in combination with psychological therapies, are now a mainstay in bulimia therapy. The antidepressant Wellbutrin, popular in part because of its especially low risk for causing weight gain, is usually avoided because it can increase the risk for seizures in patients with electrolyte abnormalities from vomiting.

Alternative Choices for Bulimia

Most alternative therapies for bulimia do not address the root causes of the disorder, but they can be helpful in relieving some of the physical distress resulting from it. If you want to include this type of treatment in your recovery, it is important to consult practitioners who are experienced in dealing with eating disorders. And be sure to tell your doctors and therapists about any complementary therapy you receive, such as acupuncture or biofeedback.

Bulimia and Mind/Body Medicine

Body exercises such as yoga, tai chi, qigong, and dance can help bulimics with their problems of body image. Reprogramming mental processes to gain control over the binge-and-purge cycles is another approach. Either hypnotherapy or EEG biofeedback may help. If you seek help here, be sure to ask hypnotherapists or biofeedback practitioners about their experience in treating eating disorders. And again, tell your doctor and other therapists about the care you get.

Nutrition and Diet's Role in Bulimia Treatment

A nutrient-dense, sugar-free diet may help reduce binge eating. Also, eliminate alcohol, caffeine, flavor enhancers, most salt, and cigarettes. Eat a balanced diet, supplemented daily with vitamin C (1,000 milligrams), vitamin B complex (50 milligrams), and a multivitamin/multimineral supplement.

Remember that treatment probably will include some retraining on how you think about food, eating, and your body. Treatment may be needed over a long period to try to win control over the binge-purge habits.

Psychotherapy of bulimia, how to treat bulimia nervosa – Central Medical Health Center “Alliance”

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The treatment of bulimia is a complex process that requires an individual approach, stages and complexity. This disease has a mental (trauma or negative attitude that caused self-rejection and a desire to lose weight) and a somatic component (the consequences of malnutrition).

Therefore, the treatment of bulimia nervosa should include the normalization of nutrition and the elimination of negative consequences (weight gain, restoration of water and electrolyte balance, vitamins) and work with the root cause.

Only the psychotherapy of bulimia can fight the cause of the disease.

How to treat bulimia

The gold standard of treatment is cognitive behavioral therapy for bulimia. This method is the most effective; additional therapeutic measures are built around it.

The essence of therapy is to teach the patient to take responsibility for nutrition.

The patient keeps a food diary and enters into it all actions in relation to food, emotions and thoughts that arise when he eats. Here, a person writes down situations in which he begins to want to eat very much and cannot stop in time.

Cognitive (attitude work) and behavioral (eating behavior) therapies are sometimes separated into two separate approaches to the treatment of bulimia. But emotion gives rise to action, so it is more correct to consider them as a single process.

Group psychotherapy for bulimia is used in the treatment - group work eliminates the feeling that the patient is alone, and positive changes in each group stimulate the rest of the result.

Family therapy for bulimia helps the patient's relatives to understand and support him in positive endeavors. Interpersonal therapy (relationship therapy) helps partners, spouses and relatives in general: children and parents, grandparents and grandchildren, people who are in more complex relationships.

Drug treatment of bulimia

Drug therapy for bulimia plays a supportive role. If there is a depressive disorder, the doctor suggests antidepressants, for anxiety - anti-anxiety drugs.


Medications don't work without psychotherapy, as soon as the person stops taking the medication, the problem returns. Therefore, with bulimia nervosa, it is necessary to seek help from a psychotherapist, and not try to solve the problem on your own.

The effect will not be immediate. The patient's condition requires work not only with the body, but also with the psyche, and this is a long process. There may be difficulties, breakdowns, not everything will work out the first time. The main thing is to believe in success and move forward.

Seeking help is the first serious step towards recovery. Illness does not need to be ashamed: if we are tormented by a severe runny nose or abdominal pain, we go to the doctor. It’s the same with bulimia, when you can’t figure out nutrition on your own, it’s better to turn to an experienced specialist.

Allianz's specialists are proficient in modern methods of treating bulimia. An integrated approach to diagnosis and treatment, a combination of psychotherapeutic, medicamentous and restorative techniques allow you to get a lasting result. We work with each case individually, taking into account all the characteristics of the patient. The result is a new, full and healthy life in harmony with the body.

Help with bulimia, psychological help, treatment of bulimia by a psychiatrist (psychotherapist)

Bulimia is a form of eating disorder in which nervous overeating is replaced by attempts to cleanse the body of food. It is a psychiatric illness, usually a stage or variant of anorexia nervosa, but may be a syndrome in some other mental illnesses. In any case, the help of a psychiatrist is required. Patients often try to hide the manifestations and symptoms of the disease, which is why they do not get an appointment with a psychotherapist for the treatment of bulimia for years.

Article content:

  • Disease description
  • Signs of disease
  • Impaired health
  • Consequences of disease
  • What help can a specialist offer
  • What is psychological therapy like
  • The importance of group training with a psychotherapist
  • Indications for inpatient treatment

As a rule, food becomes a simple pleasure. In fact, patients simply "seize" their problems and difficulties. But after breakdowns, they feel guilty and try in every possible way to minimize the consequences, so a psychiatrist should deal with the treatment.

Description of the disease

In bulimia, after eating a large amount of food, a person induces vomiting. Also, various medicines can be used - laxatives, diuretics and other drugs. Psychotherapists note that the disease is most common among adolescents, especially girls.

Signs of illness

Bulimia is a type of mental disorder with the following symptoms:

  • overeating with inability to control oneself or stop;
  • avoidance of joint meals with other people;
  • absorption of the daily norm or even more food in a short period of time;
  • attempts to hide food so that it is always at hand;
  • regular diets - including those with very tight calorie control, tormenting physical exercises;
  • maintaining or even losing weight;
  • induction of vomiting - in case of disturbed eating behavior, this is usually hidden, but you can guess from weaning to the restroom immediately after dinner;
  • poor health - constant weakness, drowsiness, fatigue;
  • low self-esteem and critical statements about their appearance;
  • mood swings, depression.

Impairment of health

For a long time, eating disorders may go unnoticed by others. Especially if the patient is hiding and does not turn to a psychologist about bulimia. After a few years, regular overeating and inducing vomiting leads to the development of symptoms associated with general health. In particular, a stomach ulcer and pancreatitis, kidney dysfunction, critical days may disappear, arrhythmia may appear, blood pressure may rise or fall.

Doctors also note the appearance of inflammatory processes in the oral cavity, erosion of the enamel. Over time, teeth may begin to fall out. No less dangerous for the body and a violation of the water-salt balance.

Consequences of the disease

If you have an eating disorder, you need the help of a psychiatrist, otherwise the symptoms get worse. Initially, vomiting may be induced once a week. But over time, artificial emptying of the stomach occurs every day, and sometimes several times.

Bulimia is accompanied by poor self-control and dissatisfaction with appearance, sometimes aggravated by a serious depressive state. Sometimes hospitalization may be required to save the patient's life.

If disturbed eating behavior is ignored, then complications such as gastritis, flatulence, liver disease, diabetes mellitus, infertility, hypothyroidism develop due to overeating and vomiting. Often, these diseases cannot be completely cured, so the patient will have to follow a diet all the time or take regular maintenance drugs.

How a psychiatrist can help with bulimia

For any eating disorder, see a psychiatrist as soon as possible. Adults and adolescents with this condition do not seek help, and bulimia can become rampant. Therefore, relatives can go to tricks and offer an appointment on any other issue.

A psychiatrist can:

  • diagnose bulimia and identify other mental problems that may have caused binge eating;
  • to determine why signs of eating disorders appeared to help recognize bulimia - the doctor is able to open the patient's eyes to the problem, motivate him to start treatment;
  • prescribe the optimal complex therapy - we are talking about the combination of psychotherapy with drug therapy and other methods.

What psychological therapy is like

Psychotherapists most often use cognitive behavioral therapy to combat bulimia. The method allows you to adjust the way of thinking and behavior of the patient. The doctor also teaches to recognize the approach of severe hunger, to cope with thoughts about food.

Interpersonal therapy is effective for people with bulimia due to depression. During the treatment of bulimia, the psychotherapist raises problems related to socialization, communication with loved ones, and teaches ways to overcome conflicts.

Psychiatrists often recommend family therapy. It can be used alone or in combination with other methods. The therapist will be able to eliminate resentment and other misunderstandings with relatives. In addition, the psychologist teaches parents and spouses how to properly support the patient. Thanks to this, the treatment is faster and less likely to relapse.

The importance of group sessions with a psychotherapist

Most often, a psychotherapist recommends coping with bulimia through individual and group sessions. Personal consultation with a psychologist for bulimia is necessary to work out personal problems, raise self-esteem.

Group classes allow you to:

  • get support – it is also provided by a psychotherapist, but understanding people with similar difficulties gives strength not to give up;
  • deal with guilt about relapses - bulimia often does not go away immediately, it is important to see that moments of weakness are normal and this is part of the treatment;
  • find motivation - psychologists note that uniting with others for a common goal gives confidence, strengthens willpower.

Indications for inpatient treatment

Experts say that inpatient treatment gives better results because external control helps to develop new eating habits and behavior in stressful situations. In addition, it is easier to combine different types of therapy.

A psychiatrist may insist on hospitalization if the patient is physically debilitated, has a history of failure in outpatient care, lacks willpower, has serious family problems, or is addicted to medication, alcohol, or drugs.

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